Addiction is a prevalent and growing concern in all aspects of our modern society. There are considerable concerns for the growing frequency of addictions to drugs, alcohol, gambling, eating and even sex. Though exercise is generally accepted as a positive behaviour, that has many benefits associated with enhanced physical and psychological well being, there is an increasing awareness that exercise addiction is becoming a common phenomenon.
Positive and Negative Exercise Addiction
William Glaser in his seminal book Positive Addiction first distinguished between positive and negative addiction to exercise; in this initial work, Glaser examined addiction in relation to running. Glaser referred to a positive addiction to exercise as involving a love of the activity that is characterized by controllability, an ability to integrate exercise into everyday activities and an ability to miss exercise sessions when it is necessary. Individuals with a positive addiction to exercise carefully schedule their exercise sessions around other aspects of their life (social, relationships and work commitments), so that their exercise schedule is not detrimental to their well being in these areas. In reality, the outcome of this positive exercise addiction is that the individual experiences increased feelings of control, competence and physical and psychological well being. In contrast, a negative addiction to exercise involved a compulsive desire/need to exercise that overrides the individual’s considerations about health, relationships and career. When an exerciser with negative addiction has to miss an exercise session, he or she typically experiences feelings of loss, guilt, physical and psychological discomfort. The term for this compulsive behavioral syndrome (addiction) within psychological research has now been frequently replaced by labels including dependence, obligatory, compulsive, commitment, morbid, excessive, habitual and chronic. However, the use of these new terms is often confusing as subsequent peer-reviewed meta-analysis research has not always clarified whether these terms represent the same phenomenon as what was intended by the label addiction.
Sachs viewed exercise addiction as forming a bipolar continuum with negative and positive addiction being placed at the extremes of this continuum. This allows individuals who exercise to be placed anywhere along the continuum, and the physical and psychological consequences of their exercise regime will relate to their position on this continuum. For example, individuals who are positioned closer to the “negative addiction” end of the continuum will typically experience greater levels of compulsion to exercise that adversely impacts on their health, relationships and career than those exercisers located towards the “positive addiction” end of the continuum who experience greater levels of control and contentment.
Veale worked towards a method of diagnosing exercise addiction that was based on the Diagnostic and Statistical Manual for Mental Disorder’s (DSM-IV: American Psychiatric Association, 1994) criteria for substance dependence that acknowledged biomedical (i.e., tolerance, withdrawal) and psychosocial characteristics (interference with social and occupational functioning). From this framework, Veale believed that exercise addiction can be operationalized as a “multidimensional maladaptive pattern of exercise, leading to clinically significant impairment or distress.”
Table 1: Diagnostic Criteria for Exercise Addiction
||Narrowing of repertoire leading to stereotyped pattern of exercise with a regular schedule once or more daily.
||Salience with the individual giving increasing priority over other activities to maintain the pattern of activity.
||Increased tolerance to the amount of exercise performed over the years.
||Withdrawal symptoms related to a disorder of mood following the cessation of the exercise schedule.
||Relief or avoidance of withdrawal symptoms by further exercise.
||Subjective awareness of the compulsion to exercise.
||Rapid re-instatement of the previous pattern of exercise and withdrawal symptoms after a period of abstinence.
||Either the individual continues to exercise despite a serious physical disorder known to be caused, aggravated or prolonged by exercise and is advised as such by a health professional or the individual has arguments or difficulties with his/her partner, family, friends or occupation.
||Self-inflicted weight loss by dieting as a means of improving performance.
Subsequent attempts to diagnose exercise addiction led Hausenblas and Downs to state that there were seven features of exercise addiction, and if an individual displayed three or more of these characteristics, he or she would meet the criteria for diagnosis as being addicted to exercise.
- Tolerance: This refers to the need for an individual to significantly increase the amount of exercise engaged in to achieve the desired effect or that there is a decreased exercise effect if they continue to train at constant levels. Aidman and Woollard questioned the appropriateness of tolerance as a diagnostic criteria because tolerance is a chronic condition that may only be experienced in the later stages of addiction.
- Withdrawal: That an exerciser will experience withdrawal symptoms (e.g., anxiety, fatigue) if they do not exercise or they have to exercise to relieve their withdrawal symptoms. Aidman and Woollard showed that club runners reported withdrawal symptoms after only one day without running.
- Intention Effects: The amount of exercise an individual participates in is greater or over a longer period of time than they originally intended.
- Loss of Control: The exerciser has a persistent desire or makes unsuccessful attempts to reduce the amount of exercise they engage in.
- Time: Large amounts of time are dedicated to exercising.
- Conflict: The exerciser reduces or gives up other important aspects of life (i.e., social, occupational and recreational) to accommodate the large amount of time they need to dedicate to their exercise routine.
- Continuance: The individual will continue to exercise even though they are aware that they have a persistent/recurring physical and/or psychological issue that has been caused or is exacerbated by exercise.
Why Do Some Exercisers Become Addicted?
Proposed explanations of exercise addiction can help to further our understanding of the issues related to this condition. Though there is still great debate about the origins of the condition, there have been several theoretical models proposed to explain its etiological underpinning.
Davis et al. explained exercise addiction as being associated with an obsessive-compulsive personality trait. Individuals addicted to exercise have also shown to score highly in personality traits such as narcissism, compulsiveness, high self imposed expectations and a high pain tolerance level.
Szabo proposed exercise addiction is a result of low levels of self esteem, and often, exercise is used to increase levels of self esteem in the sufferers. This view would seem to be supported by the negative psychological consequences of not exercising for this group as their self esteem would quickly reduce during this time due to their forced inactivity.
Thompson and Blanton produced a physiological explanation of exercise addiction termed the sympathetic arousal hypothesis. This theory explained that increased fitness levels increases the efficiency of energy utilization, resulting in decreased sympathetic nervous system output (i.e., catecholamines) and a negative state with feelings of lethargy, fatigue and low state arousal. The individual is then susceptible to becoming addicted if he or she relies on exercise to increase arousal level to optimal levels.
Increasing Client Awareness of Exercise Addiction
The use of client education and awareness strategies is a productive method to ensure your clients who may suffer from this disorder are given the opportunity to help overcome exercise addiction. The following questions and statements can form an effective guideline for an awareness campaign within your practice. These guidelines could be incorporated into semi-structured informal interviews with your clients or as a poster/information sheet for clients at potential risk.
- Do you think exercise is compulsive for you?
- Is exercise the most important priority in your life?
- Is your exercise pattern very routine and rigid? Could people “set their watches” by your exercise patterns?
- Are you doing more exercise this year than you did last year to gain that "feel good" effect?
- Do you exercise against medical advice or when injured?
- Do you get irritable and intolerable when you miss exercise and quickly get back to your exercise routine if you are forced to miss it?
- Have you ever thought you were risking your job, personal life or health by overdoing your exercise?
- Have you ever tried to lose weight just to make your exercise performance better?
If you or your clients have answered yes to most of the questions or if you or your clients are worried about becoming dependent on exercise, please seek assistance or try to incorporate these self-help strategies into your routine:
- Use cross training to avoid over use injuries; remember aerobic fitness, strength and flexibility are all important aspects of fitness.
- Schedule a reasonable rest between two bouts of exercise to prevent physical and psychological fatigue.
- Schedule one complete rest day a week and notice how energetic you are the next day.
- Exercise your mind by getting involved in mental and social activities that can lower anxiety and raise self esteem.
- Try to learn stress management techniques such as relaxation, yoga, tai chi or meditation.
Exercise addiction is an increasingly common disorder that is predominantly found in female exercisers. Female exercisers who suffer from anorexia nervosa are particularly vulnerable. An individual who suffers from this disorder can be subjected to extreme physiological and psychological distress.
It is important that personal trainers and other professionals working in the health and fitness industry are aware of the early signs and symptoms of exercise addiction to ensure their clients enjoy an adaptive, long lasting and enjoyable exercise experience.
- Aidman, E.V., and Woollard, S. (2003). The influence of self-reported exercise addiction on acute emotional and physiological responses to brief exercise deprivation, Psychology of Sport and Exercise, vol. 4, 3, 225-236.
- Biddle, S.J., and Mutrie, N.(2001). Psychology of Physical Activity: Determinants, well-being, and interventions. Routledge.
- Cashmore, E. (2002). Sport psychology: The key concepts. Routledge.
- Glasser, W. (1976). Positive addiction. Harper and Row.
- Hausenblas, H.A., and Symons Downs, D. (2002). Exercise Dependence; a systematic review, Psychology of Sport and Exercise, vol. 3, 2, 89-123.
- LeUnes, A., and Nation, J.R. (2002). Sport Psychology (3rd Ed.). Wadsworth.
- Moran, A.P. (2004). Sport and Exercise Psychology: A Critical Introduction. Routledge.
- Sachs, M.L., (1984).Running therapy for the depressed client. Topics on Clinical Nursing, 3, 770-786.